Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Yeung HC(1), Chu MK (1), Lau WS (1)
Affiliation :
(1) Department of Neurosurgery, Princess Margaret Hospital
Introduction :
Endovascular treatment has become an increasingly popular type of minimally invasive surgery worldwide, especially neuro-endovascular procedures. More than 85% of vascular punctures are at femoral artery, providing significant ease in arterial sheath manipulations. Complications like formation of hematoma and pseudoaneurysm have been observed. Although active vascular closure device is known to be effective in achieving hemostasis, it is not feasible in clinical ward setting in view of high cost and operator-dependent. Furthermore, there is no definite guideline or standard in the compression method within the hospitals in Hong Kong. Either manual compression or mechanical compression device is usually adopted in ward.
Objectives :
In order to attain the benefits of both manual compression and mechanical compression device, a pilot study was launched and it aims to investigate the effectiveness and safety of using Combined Compression Method (CCM) (manual compression and mechanical compression device) in terms of decreasing Time-To-Hemostasis(TTH) and minimizing complication rates in patients who have femoral arterial sheath (FAS) removed after undergoing neuro-endovascular procedures.
Methodology :
This pilot study was launched between April 2023 and October 2023 in the Department of Neurosurgery of Princess Margaret Hospital. Patients, who were cooperative and having FAS to be removed in ward, were recruited to the study. For cases with pre-existing oozing over groin before removal of FAS and cases not compliant to the protocol with doctor’s prescription due to foreseeable high bleeding risk were excluded. CCM refers to 15-minute manual compression, followed by 15-minute C-Clamp application. TTH and occurrence of complications like oozing and hematoma formation were evaluated. A procedure checklist including preparation and post-procedure nursing care was formulated for staff. Training was provided to both medical officers and nurses regarding to the compression technique, proper application of C-Clamp and post-FAS removal monitoring and care.
Result & Outcome :
Total 87 samples were collected till end of October 2023. 13 of them were excluded due to pre-existing oozing, and not compliant to the protocol which was overridden by doctor with high foreseeable bleeding risk. Therefore, 74 samples were included in the study. Half of the cases underwent cerebral embolization, followed by intra-arterial thrombectomy (23%), Digital Subtraction Angiography (15%) and carotid stenting (12%). Totally 69 of them were successful and no major adverse events, such as pseudoaneurysm and arterio-venous fistula were observed throughout the study. The mean TTH was 31.89 minutes. Only 2 cases of oozing and 3 cases of hematoma were reported. Only 1 case required more than 15 minutes for extra compression. These cases were associated with the use of Integrilin infusion or thrombolytics injections, which increases bleeding tendency.
The findings demonstrate that CCM is a safe and effective way to achieve hemostasis and minimize complications after FAS removal. Since medications like Integrilin and thrombolytics increase bleeding tendency, the use of active vascular closure device in radiological suite and longer manual compression time could be considered for cases who were given these infusion during intra-operation. Antiplatelet was also considered to be withheld at least 24 hours before FAS removal.
